Department of Internal Medicine, University Hospital “Shefqet Ndroqi”, Tirana, Albania
Keywords:multiple autoimmune syndrome, type 1 diabetes mellitus, Hashimoto’s thyroiditis, systemic lupus erythematosus, rheumatoid arthritis, celiac disease
Autoimmunity involves a misdirection of the body’s immune system against its own tissues, causing a large number of diseases. Various autoimmune disorders are associated with each other but it is very rare to see multiple autoimmune diseases in one patient. Multiple autoimmune syndrome (MAS) is a condition characterized by 3 or more autoimmune disorders in the same individual. Familial, immunologic and infectious factors are implicated in the development of MAS. Here we report a case of co-existence of five autoimmune diseases in a 33-year-old woman, namely type 1 diabetes mellitus, autoimmune hypothyroidism, systemic lupus erythematosus, rheumatoid arthritis and celiac disease which leads to the final diagnosis of multiple autoimmune syndrome type 3 with celiac disease. Patients with a single autoimmune disorder are at 25% risk of developing other autoimmune disorders. The present case draws clinicians’ attention to the need for continued surveillance for the development of new autoimmune disease in predisposed patients. The possibility of 3 or more autoimmune disorders occurring in the same patient cannot be fortuitous and suggests a pathogenic relationship between each of them. Presence of an autoimmune disease should elicit vigilance for another one. Occurrence of multiple autoimmune phenomena indicates the need for continued surveillance for the development of new autoimmune disease in predisposed patients. Early identification of the individual disease of MAS is needed in order to decrease the morbidity and mortality associated with MAS. Our case report is of interest because of the rare association of 5 autoimmune disorders. These autoimmune diseases in the described case led to diagnosis of multiple autoimmune syndrome type 3 with celiac disease. Moreover, this case of MAS highlights the importance of a good clinical surveillance in patients with one autoimmune disorder because they have a higher risk of developing another autoimmune disease, even rarely associated with the first one.
Anaya JM, Shoenfeld Y, Correa PA, et al. Autoimmunity and Autoimmune Disease. CIB, Medellin; 2005.
Poulain C, Johanet C, Delcroix C, Lévy-Marchal C, Tubiana-Rufi N. Prevalence and clinical features of celiac disease in 950 children with type 1 diabetes in France. Diabetes Metab. 2007;33(6):453‐458. doi:10.1016/j.diabet.2007.06.004.
Kakleas K, Soldatou A, Karachaliou F, Karavanaki K. Associated autoimmune diseases in children and adolescents with type 1 diabetes mellitus (T1DM). Autoimmun Rev. 2015;14(9):781‐797. doi:10.1016/j.autrev.2015.05.002.
Shaikh SB, Haji IM, Doddamani P, Rahman M. A Study of Autoimmune Polyglandular Syndrome (APS) in Patients with Type1 Diabetes Mellitus (T1DM) Followed Up at a Teritiary Care Hospital. J Clin Diagn Res. 2014;8(2):70‐72. doi:10.7860/JCDR/2014/7013.4011.
Rensch MJ, Szyjkowski R, Shaffer RT, et al. The prevalence of celiac disease autoantibodies in patients with systemic lupus erythematosus. Am J Gastroenterol. 2001;96(4):1113‐1115. doi:10.1111/j.1572-0241.2001.03753.x.
Chambers SA, Charman SC, Rahman A, Isenberg DA. Development of additional autoimmune diseases in a multiethnic cohort of patients with systemic lupus erythematosus with reference to damage and mortality. Ann Rheum Dis. 2007;66(9):1173‐1177. doi:10.1136/ard.2006.062984.
Buyon J, Wallace DJ. The use of exogenous estrogens, endocrine system and urogenital tract. In: Wallace DJ, Hahn BH, eds. Dubois’ Lupus Erythematosus. 6th ed. Philadelphia: Williams & Wilkins; 2002. pp. 821–841.
Cortes S, Chambers S, Jerónimo A, Isenberg D. Diabetes mellitus complicating systemic lupus erythematosus - analysis of the UCL lupus cohort and review of the literature. Lupus. 2008;17(11):977‐980. doi:10.1177/0961203308091539.
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